MRI to assist in interpretation of CT findings

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Coronal T2 fat sat

Confirmed blood in antero-medial left kidney based on morphology and signal characteristics on T1 and T2 as well as lack of enhancement.

Case Discussion

It can be very difficult to determine if a hyperdense cyst in polycystic disease contains blood or proteinaceous fluid based on the CT findings. MRI is better able to differentiate the two. Blood in this case has a morphological pattern of a peripheral bright T1 (low signal T2) rim indicative of intracellular methaemoglobin and large core of predominately T1 and T2 hypointensity indicative of deoxyhaemoglobin. This is not typical of a uniform fluid-filled structure ie cyst. Note there are adjacent cysts containing clear fluid ie low T1 and high T2 signal and proteinaceous fluid ie high T1 and low T2.